Skin injury prevention and treatment in the older person: reframing our approach in the community setting.

In the past, maintaining skin integrity has been synonymous with preventing and treating a single skin injury, namely pressure injury. However, there is growing recognition that this single-injury approach overlooks the multitude of skin injuries that may be sustained by older people. This article proposes that reframing the approach to skin integrity care away from the single-injury focus and towards a comprehensive and holistic paradigm is imperative. Guided by the Skin Safety Model, this article presents a case study illustrating comprehensive skin integrity assessment and care planning for an older person in the community setting. It is hoped that the information presented will guide community nurses in addressing skin injuries experienced by older adults in holistic and comprehensive way.

TIMERS: undertaking wound assessment in the community.

Community nurses regularly treat patients with chronic wounds (those persisting over 6 weeks); with the complexity of both the patients' health needs and the wound itself, this often becomes a highly time-consuming task for the nurse. Wound assessment tools are designed to support all qualified nurses, regardless of whether the nurse possesses specialist wound care knowledge or not, in delivering safe and appropriate wound care. The wound assessment tool, using the acronym TIME, has been recently amended to now be known as TIMERS (Tissue, Infection/Inflammation, Moisture, Wound edge, Repair/Regeneration, Social). This article will examine what the newly amended wound assessment tool TIMERS represents, in addition to looking at the practical issues around its implementation in community settings.

Moisture-associated skin damage: use of a skin protectant containing manuka honey.

The skin is the largest organ in the body, providing an effective barrier against excessive fluid loss and invasion from bacteria, but the barrier function of the skin can be lost when it is damaged by prolonged contact with moisture. Moisture-associated skin damage can be caused by prolonged exposure to perspiration, urine or faeces, wound exudate or stomal output. Prevention and treatment of moisture-associated skin damage involves application of skin protectants, but there is a wide range of these products available to nursing staff, and clinical decision making is hampered by a lack of robust comparative evidence. Medihoney® Barrier Cream may be used for a number of indications related to moisture-associated skin damage, including incontinence-associated dermatitis. The use of Medihoney Barrier Cream has been shown to lower pruritis complaints associated with intertrigo, and promotes patient comfort.

Diabetic wound management.

Diabetes is a global disease, and its prevalence has increased rapidly in the last century. Many complications are associated with diabetes, and diabetic foot ulcers (DFU) are common. There is a variety of different treatments for DFU, and the aim of this article is to discuss the factors responsible for delayed wound healing in patients with diabetes, and the treatment strategies that are available.

Cuidados com a pele do recém-nascido internado em unidade de terapia intensiva neonatal: revisão integrativa / Skin care to newborns admitted in neonatal intensive care unit:integrative review / Cuidados con la piel del recién nacido internado en una unidad de terapia intensiva neonatal: revisión integradora

Objective: To describe the nature and development in nursing scientific production on the theme “skin care tothe newborns” (NB). Method: a literature search with descriptive, exploratory and qualitative approach was carried out in the LILACS, PUBMED and BDENF databases. Eleven articles were selected. Results: after reading the studies, the analysis was performed with six national publications and five international publications. Seven studies had qualitative approach and four studies, quantitative approach. This study allowed to know the care provided and ways of monitoring the evaluation of the skin of newborns. Conclusion: few studies on care of newborn skin were found. The development of studies aiming to contribute to the preparation and review of protocols to provide care to prevent diseases in newborns is recommended.

Objetivo: Descrever a natureza e a tendência na produção científica de enfermagem sobre a temática “cuidados com a pele do recém nascido (RN)”. Método: realizou-se uma pesquisa bibliográfica do tipo exploratório e descritiva, com abordagem qualitativa, nas bases de dados LILACS, BDENF e PUBMED, com seleção de 11 artigos. Resultados: após a leitura dos estudos, foram analisadas seis publicações nacionais e cinco publicações internacionais. Sendo sete estudos de abordagem qualitativa e quatro estudos de abordagem quantitativa. Este estudo possibilitou conhecer cuidados e formas de acompanhamento na avaliação da pele do neonato. Conclusão: evidenciaram-se poucos estudos sobre a temática de cuidados com a pele do recém-nascido. Sugere-se o desenvolvimento de estudos que colaborem para a elaboração e revisão de protocolos de assistência direcionados à prevenção de agravos ao recém-nascido.

Objetivo: Describir la naturaleza y la tendencia en producción científica de enfermería en el tema del cuidado de la piel del recién nacido (RN). Método: se realizó una búsqueda bibliográfica de enfoque cualitativo exploratorio descriptivo en las bases de datos LILACS, BDENF y PUBMED, con una selección de 11 artículos. Resultados: Después de leer los estudios, se analizaron seis publicaciones nacionales y cinco publicaciones internacionales. Siete estudios con enfoque cualitativo y cuatro estudios de un enfoque cuantitativo. Este estudio permitió el conocimiento de los cuidados y formas en el seguimiento de la evaluaciónde la piel del recién nacido. Conclusión: fueron encontrados unos pocos estudios sobre el tema del cuidado de la piel del recién nacido. Se sugiere el desarrollo de estudios que contribuyan a la preparación y revisión de los protocolos de atención dirigidos a la prevención de lesiones en el recién nacido.

Use of compression therapy in patients with lymphoedema.

Compression therapy is an effective and common approach to the management of lymphoedema, a chronic condition requiring long-term treatment. Lymphoedema is caused by the accumulation of fluid in soft tissue, resulting in swelling of the affected limb or area. Lymphoedema may be primary, as a result of a genetic abnormality, or secondary, as a result of injury, including non-accidental injury, or following treatments such as radiotherapy and/or surgery. The condition is characterised by a high protein oedema and secondary skin changes. This article outlines features of the various types of compression therapy used to treat patients with lymphoedema, including details of their application, effectiveness, indications and contraindications.

Advances in wound debridement techniques.

Dead and devitalised tissue interferes with the process of wound healing. Debridement is a natural process that occurs in all wounds and is crucial to healing; it reduces the bacterial burden in a wound and promotes effective inflammatory responses that encourage the formation of healthy granulation tissue (Wolcott et al, 2009). Wound care should be part of holistic patient care. Recent advances in debridement techniques include: biosurgery, hydrosurgery, mechanical debridement, and ultrasound. Biosurgery and mechanical debridement can be practiced by nonspecialist nurses and can be provided in a patient's home, thus increasing the patient's access to debridement therapy and accelerating wound healing.

An introduction to absorbent dressings.

Exudate bathes the wound bed with a serous fluid that contains essential components that promote wound healing. However, excess exudate is often seen as a challenge for clinicians. Absorbent dressings are often used to aid in the management of exudate, with the aim of providing a moist but unmacerated environment. With so many different types of absorbent dressings available today-alongside making a holistic assessment-it is essential that clinicians also have the knowledge and skill to select the most appropriate absorbent dressing for a given patient.

Maggot debridement therapy: a systematic review.

Maggot debridement therapy is used extensively in the UK in both community and hospital situations, but remains a potentially under-used modality in many wound care markets. It promotes wound healing by performing three key processes: debridement, disinfection and growth-promoting activity. It can be used for the debridement of non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic of post-surgical wounds. With the increase in chronic diabetic foot wounds, maggot debridement therapy is a promising tool for health professionals dealing with difficult wounds. This article presents an overview of the research evidence surrounding maggot debridement therapy that serves as a guide to health professionals who may be users of this form of treatment now and in the future.

Holistic wound assessment in primary care.

Wound care is expensive and can cause immeasurable stress and inconvenience to patients and their significant others. It is therefore in the best interest of the patient, their significant others and the NHS as a whole that wounds are expertly assessed, managed and healed in the quickest timeframe possible. Nurses play a pivotal role in the process of accurate holistic wound assessment, evaluation and treatment. This article aims to help further develop and enhance both professional and clinical wound care assessment and evaluation skills. Pertinent wound care literature is critically reviewed and the crucial nature and important components of comprehensive wound assessment for facilitating the highest possible quality wound care to patients are presented alongside recommendations regarding how the enhanced knowledge and skills could be applied into everyday wound care practice.

High-output stomas: challenges with a large laparostomy wound.

This article explores the management of patients with high-output stomas fashioned under acute surgical conditions where management may be difficult owing to the presence of a large laparostomy wound. Available products that meet the technical demands required to manage these patients, achieve optimal wound healing, manage high-output stoma and encourage patient independence are considered. A number of strategies to meet the physical and nutritional requirements of these patients are discussed along with the importance of the multidisciplinary team working together to provide holistic care.

O cuidado de enfermagem com a pele do recém-nascido na unidade de terapia intensiva neonatal / Los cuidados de enfermeria com la piel del recién nacido em unidades neonatales de cuidados intensivos / Nursing care with the skin of newborn in neonatal intensive care unit

Descrever o cuidado da equipe de enfermagem com a pele do neonato internado na Unidade de Terapia Intensiva Neonatal e identificar, caso ocorram, as lesões que venham a surgir na pele desses RN. Método: Estudo qualitativo realizado em uma Maternidade Pública de Teresina–PI. Os sujeitos foram 16 profissionais da equipe de enfermagem. A produção dos dados ocorreu através de um roteiro de entrevista semi-estruturada, que, depois de transcritos, foram submetidas à análise categorial temática. Resultados: O estudo possibilitou descrever o cuidado de enfermagem à pele dos RN e as intervenções da equipe de enfermagem diante das lesões. Conclusão: Constatou-se que apesar do empenho da equipe de enfermagem em oferecer uma assistência com o menor risco para o paciente, a ocorrência de lesões na pele dos neonatos é uma realidade enfrentada por estes profissionais, devendo fazer parte de seu cotidiano reconhecê-las, preveni-las e tratá-las.

Describir los cuidados del personal de enfermería con la piel de los recién nacidos hospitalizados en la unidad de cuidados intensivos y determinar, en su caso, las lesiones que se presentan en la piel de los recién nacidos. Métodos: Estudio cualitativo, en una maternidad pública de Teresina-PI. Los sujetos fueron 16 profesionales de enfermería profesional. La producción de datos ocurrió través de una hoja de ruta para la entrevista semi-estructurada que después de transcripciones fueron sometidos a análisis de categorías temáticas. Resultados: El estudio permitió describir los cuidados de enfermería a la piel de los recién nacidos y las intervenciones del personal de enfermería antes de la lesión. Conclusión: Se encontró que a pesar del compromiso del personal de enfermería para proporcionar asistencia con el menor riesgo para el paciente, la aparición de lesiones en la piel de los recién nacidos es una realidad que enfrentan estos profesionales y deben formar parte de su rutina para reconocer, prevenir ellos y los tratan.

Objective: To describe the care of the nursing staff with the skin of neonates hospitalized in the neonatal intensive care unit and to identify, if any, lesions that arise in the skin of newborns. Method: Qualitative study in a public maternity hospital in Teresina-PI. The subjects were 16 professional nursing staff. Data production occurred through a roadmap for semi-structured interview that after transcripts were subjected to analysis thematic category. Results: The study allowed to describe the nursing care to the skin of newborns and the interventions of the nursing staff in the presence of the injuries. Conclusion: It was found that despite the commitment of nursing staff to provide assistance with the least risk to the patient, the occurrence of skin lesions of neonates is a reality faced by these professionals and should be part of their routine to recognize them, prevent them and treat them.

A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy.

PURPOSE/OBJECTIVES: To compare the effectiveness of three different skin care products versus a placebo in reducing the incidence of radiation therapy-induced skin reactions prophylactically. DESIGN: Prospective randomized, double-blinded, placebo-controlled study. SETTING: A radiation oncology department at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States. SAMPLE: 208 women with breast cancer who were to receive whole breast radiation therapy. METHODS: Patients were invited to participate after radiation therapy was documented as part of their treatment plan. Patients applied a skin care product starting on the first day of treatment and were assessed weekly by their radiation oncology nurse. MAIN RESEARCH VARIABLES: Skin reaction score and skin product. FINDINGS: None of the products were statistically better than placebo in preventing skin reactions. Increases in skin reaction over time did not vary with treatment group for the linear (p = 0.16) and nonlinear (p = 0.94) effects of time and for both time components tested together (p = 0.41). CONCLUSIONS: Ninety-five percent of women participating in this study experienced a radiation therapy-induced skin reaction. IMPLICATIONS FOR NURSING: The development of guidelines to support safe patient care is encouraged because patients prefer to take action rather than do nothing. However, the findings do not demonstrate improved clinical outcomes with the use of skin care products. Healthcare providers should proactively educate patients about acute skin reactions and self-care strategies to minimize skin breakdown.

Understanding wound bed preparation and wound debridement.

Wound bed assessment and optimum local wound care are essential to facilitate the wound healing process. The presence of devitalized tissue, for instance necrotic tissue or slough, is common in hard-to-heal wounds and acts as a barrier to healing. There are several debridement options available to the practitioner with the choice of wound debridement technique being made following a holistic assessment of the patient and the wound. The method of debridement should be discussed with the patient and family where appropriate and consent to treatment obtained prior to the procedure being undertaken.

Malignant fungating wounds: managing pain, bleeding and psychosocial issues.

Management of these non-healing wounds typically involves practices that diverge from those used in other settings. The final article of this four-part series explores the holistic approach required in dealing with the complex symptoms.

Malignant fungating wounds: key symptoms and psychosocial issues.

Living with a malignant wound can be an overwhelming experience for the patient and their family, yet the psychosocial effects are often overlooked at assessment. If care is to be holistic, then these issues must be addressed.